Provider Demographics
NPI:1043284961
Name:MANNING, JOHN THOMAS (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:MANNING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 SHADY PATH
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-7209
Mailing Address - Country:US
Mailing Address - Phone:252-764-9083
Mailing Address - Fax:910-554-1915
Practice Address - Street 1:111 SHADY PATH
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-7209
Practice Address - Country:US
Practice Address - Phone:252-764-9083
Practice Address - Fax:910-554-1915
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007862363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics